Ear, Nose and Throat

UT Health East Texas provides a wide range of ear, nose and throat services from comprehensive diagnostics to medical and surgical treatments for disorders of the ear, nose, throat, head and neck. Our mission is provide the highest quality ENT care available with the personal plan that best meets your needs for children and adults.

From in clinic treatments like tinnitus to surgical treatments of the head and neck, UT Health East Texas ENT physician, Tina P. Elkins, MD, can care for all your ENT needs.

We offer diagnostic testing, imaging, advanced procedures and surgeries.

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To learn more about ear, nose and throat services or to schedule an appointment, call 903-676-3316.

Featured Content

Doctor at UT Health East Texas talks the importance of Kids Ear, Nose, Throat Awareness Month

Preventing Noise-Induced Hearing Loss

As I drop my children off for school, walk through an airport or look out into my office waiting room, I see people of all ages wearing various types of headphones and listening to their phones or tablets. As the surrounding environment becomes noisier and noisier, the volume of the device slowly increases to maintain the clarity of the sound. Currently, the CDC has shown that one out of 10 children aged 6 through 19 is experiencing some level of noise-induced hearing loss. This is why it is important to understand how loud noise exposure affects the inner ear, the ear signs of hearing loss and how to prevent this in all age groups.

Noise-induced hearing loss in our younger generation is more common today than it was 10, 5 or even 2 years ago. As younger generations are plugging in for longer periods of time we are seeing a damaging effect on their hearing. It is important that we all recognize the signs of hearing loss so that it can be quickly diagnosed, the volume turned down and hopefully the hearing return to normal.

How does loud noise affect the inner ear?

The sound pressure wave that comes from the headphones results in increased vibration of the cochlear hair cells in the inner ear, potentially causing injury. Think of this as a wave crashing on a beach. The larger and stronger the wave, the more force as it hits the sand resulting in more erosion. The same is true for a sound pressure wave. The stronger the wave, the more injury it has on the inner hair cells, especially those in the higher frequencies. With repeated exposure, there is high risk of irreversible damage.

What are the signs someone with noise-induced hearing loss might experience?

At first, a person may complain of ear ringing (tinnitus), muffled hearing (due to a hearing threshold shift) and trouble understanding speech when there is background noise. Some patients may initially express increased sensitivity to sound. They may say that everything is too loud (hyperacusis) or painful with exposure to loud sounds. Recognizing the early signs of loud noise exposure can be beneficial in preventing the permanent effects. If the signs of hearing loss persist it is important to have a hearing test performed by a licensed audiologist. The audiologist will be able to do comprehensive testing to identify any signs of hearing loss, especially in the high frequencies. If a hearing loss is identified, counseling on reducing the noise exposure will be given and most likely with a repeat hearing test at a future date to evaluate for any improvement.

How to prevent noise-induced hearing loss?

Start by turning the sounds down. Portable hearing devices, when turned up to their maximum volume can produce sounds at 85 decibels (dB) or higher. Some music can reach levels up to 110 dB. Even less than two minutes with exposure at this level can permanently damage hearing. This is equivalent to engine noise (85 dB) or an ambulance siren (120 dB). It is recommended that the sound stays at 50% volume, which is around 70-75 dB thus almost eliminating the risk of noise damage. The volume should not be so high that others can hear it or that the listener cannot hear sounds around them. Most personal devices have the ability to monitor the sound levels a person is exposed to and can alert you if a maximum amount of sound has been reached for a day or week. Parents also can set limits on their child’s portable device, in most cases, that limits the volume it will play at. However, most children are tech-savvy enough to override this, so it is important to not just rely on this safeguard. Talking to your children about the effect, especially the middle and high school students, is important so that they can take an active role in preventing hearing loss.

Information provided by Tina Elkins, MD, board-certified otolaryngologist (ENT) at UT Health East Texas Physicians in Athens, who sees patients of all ages. As an otolaryngologist, Dr. Elkins specializes in treating conditions affecting the ears, nose and throat either medically or surgically. Call 903-676-3316 to make an appointment.

Common Pediatric Ear and Throat Disorders

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Common Pediatric Ear and Throat Disorders

Robert N. Strominger, MD, board-certified otolaryngologist at UT Health East Texas Ear, Nose and Throat Center discusses common pediatric ear and throat disorders.

Men’s Hearing Health

June is Men’s Health Awareness Month and a great time to shed light on factors that can lead to hearing loss and signs that hearing aids are needed.

Job occupation can be a significant reason for hearing loss. Occupations such as firefighters, police officers, construction workers, oil field workers, music performers and landscaping workers can all lead to exposure to sounds at harmful levels.

Sound is measured in decibels (dB). A decibel is a degree of loudness or is a unit used to measure how powerful or loud a sound or signal is using a logarithmic formula. Certain tools or equipment can emit decibels at 85 or higher causing permanent hearing damage. Examples of harmful sounds workers may experience include:

· Lawnmower - 90 dB

· Belt sander - 93 dB

· Gunfire - 140 - 165 dB

· Fire sirens - 65 - 120 dB

· Bulldozer - 105 dB

· Chainsaw - 110 dB

· Jackhammer - 120 dB

If you are unable to remove yourself from the situation, then hearing protection is key to prevent hearing loss. However, if hearing protection is not used consistently or correctly exposure can still lead to damage.

Signs you may need hearing aids:

· You hear but do not understand others when they are speaking.

· You think everyone is mumbling or talking too low.

· You often ask for repetition.

· Friends and family tell you that you are not hearing them.

· You do not participate in a conversation, because you are not following along.

· You stay at home rather than enjoying group outings.

· You feel like you need to see the person speaking in order to hear them or you are reading lips.

· You are tired after having a conversation or after a day at work or school.

· You have a hard time hearing the phone.

· You watch the television at a very loud volume.

· You have difficulty hearing background noise.

· You hear ringing, buzzing or humming sounds in your ears.

There are many signs that you may need hearing aids. If any of the above statements are something you experience, it may be time to schedule a hearing test to see if hearing aids can help. Many times others will notice that you have difficulty hearing before you do. Hearing loss often occurs gradually, so you may be unaware of just how much you are missing.

When you listen to speech with a hearing loss, your brain is working hard to “fill in the gaps” because you are missing important speech information. This is why you may find yourself reading lips or searching for context clues in conversation. The longer you go with hearing loss, the more difficult it is for your brain to fill in those gaps. Individuals with long-term hearing loss have increased difficulty understanding, even when speech is loud enough. Because your brain is working harder to understand, you may be more fatigued after long conversation or a day at work.

Therefore, it is important to start wearing hearing aids as soon as hearing loss is identified. Keeping your brain stimulated with sound is imperative and may help prevent increased cognitive decline. Additionally, tinnitus (ringing, buzzing, humming or other sounds that you hear without an external source) can be a sign of hearing loss. Tinnitus may be improved by the use of hearing aids due to the additional sound stimulation to your brain.

If you are experiencing any of the symptoms above, call 903-747-4098 to schedule an appointment.

Information provided by Danielle Dupuis, AuD, CCC-A. Dr. Dupuis is located at the UT Health East Texas ENT Center in Tyler and is accepting new patients. For more information, visit uthealthtylerhospital.com/services/ear-nose-and-throat.

Surgical Thyroid Options

The development of a benign multinodular goiter is a normal aspect of aging and a majority of women will develop goiters later in life. Very few of these nodules are cancer. However, as a result of the increasing use of diagnostic imaging involving the neck, more and more thyroid nodules are discovered; therefore more cancers are being detected in patients.

Two common scenarios are a thyroid nodule is seen on a CT scan with a follow-up thyroid ultrasound or a thyroid ultrasound is ordered because a palpable nodule needs ultrasound examination. This may lead to a fine needle aspiration biopsy and the diagnosis of thyroid cancer and the need for thyroid surgery. If not for the use of these imaging modalities and modern biopsy techniques, many people would never know there was cancer, because most thyroid cancers are not aggressive and would never be a problem.

Even with all of the additional thyroid surgeries that have been performed, the mortality rate of thyroid cancer has not changed significantly over the years. In general, thyroid surgery is a safe operation with a low complication rate. It is important to be selective in who needs surgery because some surgery can be avoided or in some cases a less aggressive surgery performed.

By understanding the behavior of thyroid cancer, the ultrasound characteristic of the nodule (Ti-RADS score) and long-term outcomes of treatment, recommendations can be made as to whether surgery is needed or not, what surgery to perform and whether postoperative I-131 radiation therapy is needed.

The physicians at UT Health East Texas ENT Center can help guide the patient through the process of diagnosing and determining a treatment recommendation for thyroid cancer. They work as a team to provide the best possible outcome.

Information provided by board-certified otolaryngologist, head and neck surgeon, Robert Strominger, MD, at the UT Health East Texas ENT Center on Three Lakes Parkway in Tyler. For more information or to schedule an appointment, call 903-747-4098 or visit uthealthtylerhospital.com/services/ear-nose-and-throat/head-neck-surgery.

What to Expect When Diagnosed with Head and Neck Cancer

There are few diagnoses more difficult to share with a patient than head and neck cancer. Head and neck cancer is synonymous with squamous cell carcinoma (HNSCCA). When talking about HNSCCA we are referring to cancer that has developed on a mucosal surface somewhere within the upper aerodigestive tract; for instance, on the tongue or on a vocal cord. Squamous cell carcinoma can also develop in the lungs and on the skin, as well as on other sites.

HNSCCA is a very aggressive cancer that has the propensity to metastasize early on in the disease course to the lymph nodes in the neck. In fact, many cancers will first present with a neck mass because the primary cancer in the throat may remain asymptomatic. However, a patient may develop progressive hoarseness if it is a vocal cord cancer; or have a painful ulcer on the side of the tongue that slowly gets bigger if the cancer is on the anterior tongue. If left untreated, HNSCCA will develop distant metastases commonly to the lungs, liver, brain or bone.

Historically HNSCCA almost exclusively developed in patients who smoked and drank alcohol. Of course, this still occurs, but now there is growing number of nonsmokers developing human papilloma virus (HPV) mediated HNSCCA. This is usually in the oropharynx - tonsil and base of tongue and occurs at a younger age than is typically found with cancers that develop from smoking. This is a very aggressive form of HNSCCCA. Luckily, it usually responds well to treatment.

Diagnosing, staging and determining treatment takes a multidisciplinary approach. The patient usually is evaluated by otolaryngology - head and neck surgery, radiation oncology and medical oncology. The necessary biopsies are obtained either in clinic or in the operating room if needed. Imaging, including CT, MRI and PET scans, as needed for that particular patient are obtained as well. Results are discussed in a multidisciplinary tumor board, which includes the above specialties, as well radiology and pathology. The American Joint Commission on Cancer (AJCC) staging is determined and the National Comprehensive Cancer Network (NCCN) treatment guidelines are recommended.

The primary goal of treatment is cure. With head and neck cancer, we also have to be very concerned about the functional status of the patient after treatment. Depending on the site and stage of the cancer, this may be single modality therapy with surgery or radiation, or in more advanced cancers multimodality therapy with surgery and radiation or radiation and chemotherapy. Sometimes in very advanced cancers all three modalities are needed.

At UT Health East Texas we have spent the last year developing a multidisciplinary head and neck cancer surgery program. This is led by the otolaryngology - head, neck, and facial plastic surgery program. Otolaryngologists Robert Strominger, MD, and Christopher Perro, MD, work as a surgical team to perform advanced head and neck surgery. This ranges from partial glossectomy with modified radical neck dissection to transoral microlaryngeal surgery with laser resection of a base of tongue cancer to total laryngectomy with bilateral modified radical neck dissection, depending on the location and extent of disease. They collaborate with Paul Critelli, MD, microvascular reconstructive surgeon, if an advanced reconstruction is needed, such as a free tissue transfer.

Information provided by Robert Strominger, MD, at the UT Health East Texas ENT Center on Three Lakes Parkway in Tyler. For more information or to schedule an appointment, call 903-747-4098 or visit uthealthtylerhospital.com/services/ear-nose-and-throat/head-neck-surgery.

When to See an Audiologist

There are many reasons to have your hearing evaluated by an audiologist. Hearing loss may occur as a result of genetics, aging, medication side effects, pathology of the ear, loud noise exposure, and much more. Hearing loss can happen suddenly or your hearing may slowly worsen over time. If your hearing loss is gradual, others may notice that you are having difficulty hearing before you do. It is important to have your hearing checked as soon as you notice changes in your hearing. Untreated hearing loss may lead to poor understanding, fatigue, depression, and social isolation.

If any of the following applies to you, you should make an appointment with an audiologist:

You have difficulty hearing or understanding speech
Others often have to repeat themselves for you
You notice changes or fluctuation in your hearing
You hear better in one ear than the other
You “hear” but you do not “understand” what is being said
Family and friends are frustrated because you do not seem to listen
You have trouble following the conversation when multiple people are talking
You hear ringing, buzzing, hissing, or other sounds that are not heard by others
Family members tell you that you turn the radio or TV too loud
You have a hard time hearing in noisy environments
Your ears feel plugged or full
You find yourself having to focus harder or read lips to understand speech
You respond inappropriately because you mishear what is being said
You find that many people mumble or do not speak clearly
You avoid social situations because you do not want to feel left out of conversation
You have family history of hearing loss
You have a known hearing loss that should be monitored annually for stability

Consider having your child’s hearing evaluated if you notice any of the following:

Your child struggles to hear in noisy environments
Your child frequently says “what?” or “huh?”
Your child does not seem to listen or has difficulty following directions
Your child returns home from school unusually tired or irritable
Your child has academic difficulty
Your child focuses intently on your face while you are speaking
Your child has speech or language delays
Your child’s teacher reports that your child seems “bored” or they are not paying attention
Your child shows signs of stress or anxiety in the classroom

The audiologist may recommend hearing aids or refer you to another provider, like an otolaryngologist, for treatment of your hearing loss and other symptoms. If it is determined that you have hearing loss, it is important to have your hearing rechecked every year.

Information provided by Danielle Dupuis, AuD, CCC-A, an audiologist at the UT Health East Texas ENT Center on Three Lakes Parkway in Tyler. Call 903-747-4098 to schedule an appointment or visit uthealtheasttexasdoctors.com/services/ear-nose-and-throat/audiology.

What is Tinnitus?

Tinnitus is a ringing, hissing, buzzing or roaring sound perceived by an individual in the absence of an actual external sound source. Though some are unbothered by tinnitus, many find it burdensome or even debilitating. Tinnitus is not a disease, but is instead a symptom of an underlying health problem. In fact, there are around 200 different health disorders that can cause tinnitus. In most cases, it is not a sign of a serious illness or condition.

It is best to see your hearing health provider or your family physician to determine if there are any underlying health issues that may cause tinnitus.

What causes tinnitus?

Tinnitus may be a result of hearing loss, stress, side effect of medication or other underlying diseases of the ear or brain. Underlying causes of tinnitus are quite varied, but the most common reason for tinnitus is damage to the tiny sensory hair cells of the cochlea in the inner ear. Risk factors include sustained or continuous exposure to loud sounds, including in the workplace or at a concert. Other causes of tinnitus may include:

Obstructions in the middle ear
Head and neck trauma
Ear infections
Cardiovascular diseases
Diabetes
Anxiety
Depression
Insomnia
Ménière’s disease
Temporomandibular joint (TMJ) disorders
Sinus pressure and barometric trauma
Traumatic brain injury (TBI)

Tinnitus prevention

One way to try to prevent tinnitus is to limit your exposure to loud noises. Sounds above 85 decibels are considered loud and any continuous exposure could lead to hearing loss and possibly tinnitus. To give you an idea of how loud that is, a leaf blower is about 85 dB, while a motorcycle sits at about 100 dB and a music concert is about 110 dB.

Four ways to prevent tinnitus:

Step away from any loud sounds.
Use hearing protection like earplugs or earmuffs.
Turn down the volume on your electronic devices like your smartphone or headphones.
Consider downloading an app that measures noise levels and sets a limit on how loud you can listen to audio and video content on your devices.

How is tinnitus treated?

Tinnitus can sometimes be relieved by listening to white noise, nature sounds or music. Tinnitus is most commonly reported as bothersome when an individual is in a quiet setting. For example, many patients complain of tinnitus when trying to fall asleep at night. If tinnitus keeps you awake at night, try using a white noise machine or a box fan to “mask” the tinnitus. If tinnitus is a result of hearing loss, hearing aids often help to diminish the perception of tinnitus because the brain is stimulated with sounds that it does not usually hear.

Tinnitus can create undue stress. We want to help patients to understand their tinnitus and develop lifestyle strategies to better manage it. It is important to check with your doctor if you experience tinnitus; particularly if it is a new symptom, if it is heard only in one ear or if it is pulsatile (sounds like a heartbeat).

Information provided by Danielle Dupuis, AuD, CCC-A, an audiologist at the UT Health East Texas ENT Center on Three Lakes Parkway in Tyler. If you are suffering from tinnitus, call 903-747-4098 to schedule an appointment.

Diagnosing and Treating Voice and Swallowing Issues

Your ability to speak can influence how well you communicate with those around you. Your ability to swallow can affect what and how much you eat and drink, which can have a tremendous impact on your overall health. For these reasons, issues with your voice or swallowing can greatly affect your quality of life. The UT Health East Texas Voice and Swallowing Clinic can help.

The clinic takes a multidisciplinary approach to diagnosis and treatment, employing a speech therapist, Stacy Dickerson, CCC-SLP, and an otolaryngologist-head and neck surgeon, Robert Strominger, MD. We specialize in the treatment of voice and swallowing disorders.

By combining the expertise of both specialties, we are able to provide a comprehensive evaluation of voice and swallowing disorders using state-of-the-art equipment, make a diagnosis and develop comprehensive treatment recommendations in a timely and efficient manner.

The clinic serves patients who are experiencing a wide variety of voice and swallowing issues. Patients who may benefit from a consultation include:

Those experiencing hoarseness, change in vocal quality or change in pitch range.
Professional voice users who experience altered vocal performance, vocal fatigue or pain.
Those suffering from disorders of the larynx due to neurological conditions, such as vocal cord paralysis, tremor and spasmodic dysphonia.
Professional voice users in need of preventive care and vocal hygiene education.
Anyone experiencing difficulty swallowing following a stroke or as a result of Parkinson’s disease or other neurodegenerative disorders.
Patients in need of swallowing and voice rehabilitation following treatment for head and neck cancer.

Additionally, we utilize a detailed, comprehensive history and physical focusing on your chief complaint, as well as advanced high-definition imaging of your vocal cords and/or swallowing function to aid in diagnosis.

Flexible nasolaryngoscopy is a procedure we use to examine the larynx (voice box) and pharynx (throat). A thin flexible endoscope is passed through the nose into the throat. This allows for the assessment of the anatomy and function of the larynx and pharynx for the production of voice and swallowing.

During a voice assessment, videostroboscopy can be performed to further evaluate the vibratory behavior of the vocal cords. During a swallowing assessment, functional endoscopic evaluation of swallowing (FEES) is performed, which allows for the visualization of the throat while drinking water and foods of various consistencies. Different compensatory strategies may be tried during swallowing to see if they are effective.

The information obtained from this testing is used to make medical, surgical, dietary and speech or swallowing therapy recommendations as needed. After treatment, patients return to the clinic to assess their response.

The UT Health East Texas Voice and Swallowing Clinic is located in the UT Health East Texas ENT Center at 2210 Three Lakes Parkway in Tyler. For more information or to schedule an appointment, call 903-747-4098.

Information provided by Robert Strominger, a board-certified otolaryngologist-head and neck surgeon at UT Health East Texas ENT Center on Three Lakes Parkway in Tyler. For more information, visit UTHealthEastTexas.com or call 903-596-DOCS.

HPV and Cancer Concerns

After an extended summer break thanks to COVID-19, many parents are looking toward the fall and the start of a new school year. With that comes back-to-school physicals and updates on immunizations.

If your child is a tween, you should make sure he or she receives the human papillomavirus (HPV) vaccine. HPV is a sexually transmitted disease that can lead to a variety of cancers, such as cervical, penal, anal, vaginal and throat.

As an otolaryngologist-head and neck surgeon, I frequently work with patients diagnosed with throat cancer. Since the 1960s the incidence of HPV-positive oropharyngeal squamous cell carcinoma (HPV+ OPSCCA), a type of throat cancer, has increased exponentially and in one study increased more than 225 percent from 1998 to 2004. It is now the leading cause of HPV associated cancers in humans, having surpassed cervical cancer. Also, men are at increased risk of developing HPV+ OPSSCA compared to women.

Historically, head and neck cancer, including oropharyngeal cancer, was primarily associated with smoking and drinking alcohol. With the decrease in smoking rates, the incidence of smoking-related cancer has decreased and now HPV-associated head and neck cancer account for about 75 percent of all head and neck cancer and about 90 percent of oropharyngeal cancers.

Unfortunately, patients with HPV+ cancers tend to be younger and healthier with a median age of 54, often without a history of smoking and drinking. Risk factors include a genetic predisposition, early onset of sexual activity and multiple sexual partners, and a previous history of anogenital warts. But in many cases, these risk factors do not apply.

The primary cancer in the oropharynx (a part of the throat) tends to remain asymptomatic until very large, and there is no screening test equivalent to the PAP smear for cervical cancer. Therefore, patients often present with a neck mass after the cancer has metastasized into the neck. With very large primary cancers not amenable to low morbidity surgical therapy, treatment with both chemotherapy and radiation therapy is often required. Luckily, despite the aggressiveness of HPV+OPSCCA, it tends to respond well to therapy and has a much better prognosis than HPV-negative cancer.

HPV is now the most common sexually transmitted infection worldwide. The CDC estimates that up to 75 percent of the U.S. reproductive-age population has been exposed to HPV. Transmission is via sexual contact, including orogenital contact leading to oropharyngeal HPV infection. Most HPV infection is asymptomatic and clears spontaneously within a couple of years. However, if tested for HPV, an oropharyngeal infection can be found in about seven percent of people.

There is no way to predict whether HPV will lead to cancer, and if so, wherein the oropharynx will occur. So preventive treatment after exposure is not possible. Of 100 strains of HPV, about 35 are thought to have the potential to lead to cancer. The most common, and in the case of oropharyngeal cancer, HPV 16 is the primary culprit.

Because there is no prevention after infection and treatment can be so devastating, it is imperative that both boys and girls be vaccinated against HPV infection. The American Academy of Pediatrics (AAP) recommends that children get two doses of the HPV vaccine at ages 11 to 12, or three doses during the teen years if they missed getting it earlier.Following the guidelines, the younger the vaccination is given the more likely it is to prevent infection and future cancer. It is estimated that this will prevent thousands of cases of HPV+ OPSSCA.

For more information on vaccinating your child or children against HPV, talk to your pediatrician or another healthcare provider.

Information provided by Robert Strominger, MD, a board-certified otolaryngologist-head and neck surgeon at UT Health East Texas ENT Center on Three Lakes Parkway in Tyler. For more information, visit UTHealthEastTexas.com or call 903-596-DOCS.

Providers For Ear, Nose and Throat

Tina P. Elkins, MD
Ear, Nose & Throat (ENT)